I returned to work this week and feeling great!  

On Monday and Tuesday I was using my knee brace to stand and treat some patients but it made my leg very itchy after. The brace also fit me abnormally since I was so short so the brace started at my groin and went all the way down to my ankle. I have large quads and skinny ankles so the brace will slip as I walk, then when I sat down, the straps that was tightly cinched to avoid slipping, would press into my incisions and force bend my knee in a uncomfortable position. My doctor gave up with my persistent complaints about my knee brace and told me to get rid of it completely.  

I am now walking around without the brace and today, not using any crutches as well. I take slow steps, making sure I bend my knee during the swing and activate my quads during midstance. I feel a stiff band wrapping from my outer thigh across my quad to the inside of my knee and it begins to hurt more when I bend my knee. One of my coworkers stretched and released my TFL, quads, and hamstring today, eliminating those symptoms and I was able to bend my knee to 108 deg! My goal is to hit 115 deg by the end of the week and continue with my BFR and standing exercises.  

I also will occasionally feel my knee buckle if I forget to activate my quad during the first few steps of walking. I ordered this light knee brace on Amazon to help with creating neuromuscular tactile cueing while I walk and prevent knee bucking. Soft Knee Brace 

10/27/22

Woke up yesterday with my harvest site incision hot and swollen. The night before, I was doing some scar mobs and pus came out of a healed incision. Yesterday morning it is angry and I was able to drain some more pus from the area. I went to see my ortho surgeon and we realized that my body was not dissolving sutures as fast as a normal person. He picked at scab at another incision site, found the end of a suture, and pulled out a long undissolved suture. He dug around the abscess area but could not find the irritating suture.  I was prescribed antibiotics for 1 week and instructed to keep draining the area as tolerated.  

Today I was at work and had drained the area twice already. However, after being stretched out, my knee felt really swollen and hot, so I wanted to try to drain it one more time. When I was pushing on the region, I saw a suture poking out. I gathered the courage to pull on the ending and the suture kept coming out. It was over 2 cm long and my tissue/pus had grown around it. It looked like I was pulling out a parasite and I was gagging so hard in the corner of my clinic.  

However, after I pulled the suture out, the pain in the front of the patella was gone. I was walking a lot faster with no limp and catching in the front of my knee. Amazing how a small suture snag can cause so much discomfort in my knee. And doc said luckily we caught it early and it was only a suture abscess and not a true infection, that would be more widespread and a HUGE issue.  I just need to finish out this antibiotic and hopefully the swelling and eczema flare up will FINALLY subside.  

Area of suture abscess before it got angry… 

The day after and pus had built up underneath. I went to go see my doc this day. 

So it wasn’t an infection, just a suture abscess. In this video, I had just came back from the doctor and he asked me to continue to drain the area if I can. (Not for the squeamish) 

In this video, the suture had peaked out and I thought the suture was going to end there. However, after I put the camera down and started pulling more, it kept coming! (Not for the squeamish) 

This is 2/3 of the suture… 

Oh and Doc said, No BFR, therabands, brace or anything that will go around my knee to reduce the variables that can contribute to my skin irritation until I finish my antibiotics. Traditional PT only. 

The post 10 – My ACL Journey – Return to Work and An Unexpected Suture Abscess! appeared first on MOTI Physiotherapy.

I don’t think I do well with consecutive days of Tylenol (600mg) and Motrine (800 mg). It killed my stomach last night when I woke up with the same stomach pains I had when I was going through gastritis. It feels like someone is scrapping in the inner lining of your stomach. The only thing that relieves the symptoms is if I eat or take Tums and Pepto Bismal.  

I also realized quickly I cannot eat anything acidic, citric, or spicy. I had to stick to my soups and ice creams, alternating it with Tums and Pepto. I completely stopped taking Tylenol and Ibuprofen today so my knee is definitely more swollen. I switched to turmeric vitamins to help reduce inflammation but that irritated my stomach also, so I had to stop that as well.  

Things that I could eat…. 

Milk; Cream; Ice cream; Saltine crackers; Broccoli cheddar soup; Mushroom cream soup; Chicken soup; Pho; Water 

Things I could not eat…. 

Coffee; Orange juice; Alcohol; Spicy things; Over seasoned things like Indian food or curries; Any tomato based soups, pasta, or spreads; Ketchup; Chocolate; Candies 

10/8/22

The universe wanted me to challenge me a little bit more so on top of a recovering knee, stomach issues, and my period….I am also allergic to something. It started around my incisions and I thought it was new skin healing kind of an itch. However, it spread up my thigh and get really hot and raised. My doc thinks its allergic reaction to something and instructed me to stop covering my knee with anything, no more brace, and take antihistamines. He also prescribed a steroid ointment to apply over the itchy regions.  

 I can only relate the itch to having a thousand mosquito bites on your leg, the kind of itch that will wake you up from a deep sleep in order to scratch your skin until it hurts. I thought I was safe inside, away from the Los Angeles Tiger Mosquitos that infest our backyards. I would rather bend my knee in the middle of the night and feel pain instead of the itching sensation on my skin.  

Since I can’t wear the brace, I had to put some extra work into strengthening my quads so my knee doesn’t buckle when I walk. Walking is a lot slower, more focused, with purpose and good gait mechanics. I also avoided shorts because it allowed for things to brush against my leg and create a world of itching. Leggings are my best friend at the moment and icing my knee/skin is also an itch lifesaver.  

Doc says it could take weeks for my body to flush the allergy out of my system and for it to stop itching….praying for a miracle before I go insane scratching.  

10/12/22

Good news today, my stomach finally stopped hurting and I can stop eating Tums and Pepto Bismal! Thank goodness I can tolerate normal food now. I am so happy I don’t wake up in the middle of the night with an angry tummy anymore.  

My incisions are finally healed and there are no openings or leaking from any of the wounds! Now I can start addressing my nasty hives, scars, and dry skin.  

My doctor prescribed me a steroid ointment that I used for the first few days but it did not help with the itching at all. It actually made my skin and scar darker and a leather texture. Honestly, the only thing that helped my icing the itchy region immediately and the cold stopping the itching and spread. I also used a non-scented lotion on my leg to prevent itching from dryness and my ezcema.  

I bought silicone patches and Mederma topical creams to use on my scar next week when all my incisions are completely healed over with no scabs.  

Today I also had enough quad activation to maintain when I am weight bearing on it. I was able to take a couple of small steps without my brace or crutches without my knee buckling. Even though I can do it, I still will use my knee brace and crutches until my knee is really stable to walk without any assistive device.  

Being a good patient is very difficult for me, especially with my rehab background, to want to stick to the script. I feel like my body is able to push and do more than the regular patient but I hear my husband in the background scolding me for being a bad patient.  

The post 9 – My ACL Journey – Post Op Stomach Pain, an Allergic Reaction, and First Steps! appeared first on MOTI Physiotherapy.

My surgeon called me today and told me to come in early because he wanted to take a look at my knee. Dr. Mehran took off my steris-trips and replaced them with some new ones. He also cut the end off my stiches and told me the ones inside my knee are dissolvable. Fun fact, it is not a comfortable experience to get steri-strips yanked off and stitches tugged on. However, it’s fast and tolerable. 

I remember before going under anesthesia, I was asking the nurses repeatedly…”MAKE SURE YOU ASK HIM TO TAKE PICTURES.” And man did they follow through. Dr. Mehran took a bunch of photos arthroscopically for me and showed me what was going on inside my knee. Let me share! 

In images 1-3, you can see my clean joint space and healthy and undamaged cartilage inside my knee.  

Image 4-9 shows my torn ACL. 

Images 12-14 shows my own ACL being repaired and achored into the wall. 

*** Dr. Mehran then flexes and extends my knee to test the integrity of the repaired ACL. He said the sutures complete shredded my ACL, showing that my ACL is unrepairable. He then quickly pivoted to harvesting my quad tendon and performed a ACL reconstruction.**** 

Images 15-16 is of my new ACL in it’s home.  

10/6/22

I am so happy with my progress thus far. I have the correct amount of extension and progressing everyday with my flexion. This was my rehab protocol at home for the first three weeks post op.  

Doubling up on BFR and Powerdots 

Getting Knee extension to 0 

Sitting on my recliner couch to dangle my feet. I would start with the recliner up and slowly retract the recliner so I could get close to 90 deg. 

My Rehab Regimen – Quadzilla Here I COME!!! 

My first straight leg raise!

The post 8 – My ACL Journey – Post Op Review and Early Rehab appeared first on MOTI Physiotherapy.

I decided tonight to skip on the oxy and continue with just Tylenol and Motrin. My husband left me an oxy pill on my side table just in case I wake up in pain but I never ended up using it. Sleeping in a knee brace locked into extension is not very comfortable. Being a side sleeping, I would toss and turn often during my sleep so trying to sleep like a vampire on my back was the worst thing I could go through. I found that if I actually slept on my affected side, the knee brace protected my knee in place and I was more comfortable on my left hip. My unaffected leg was on top and I propped it up on the wedge so keep it from touching my other knee. Throughout the night I would alternate between sleeping on my back and on my left side. 

My lower back suffered the most, waking up with a lot of stiffness and soreness in my lower back and SI joints. I had to thoroughly stretch out every morning before I woke up or I would end up limping more because I developed sciatic pain in my left glute.  

Thank goodness I don’t have work tomorrow, because ACL, you are killing me. 

9/30/22 – First Shower Post-Op

Nothing is more humbling than allowing another person to do everything for you. Before my surgery I had planned out my bathroom layout, putting items in reachable area…smart placement of stools, towels, trash bins, etc so I could maneuver the bathroom independently. I even tested out trying to do multiple showers on one leg and testing out standing positions, sitting positions, where I could prop up my knee. 

All that sense of “independence” went out the window after surgery.  

The day after surgery, my husband helped me undress and wipe my entire body down with a towel. You will never feel loved until someone hand wipes your body as they also try to hold you up from falling over. Thank god that only had to happen twice and I thank my husband over and over again for supporting my hygiene.  

My surgeon allowed me to shower today, 3 days post op, since my incisions were small. His instructions were, let the water and soap glide over your wound, no need to cover and don’t soak it. I was honestly scared of removing the bandage, anticipating minced meat underneath, so I decided to do it after the shower. Also, for some reason, leaving the bandage gave my knee a layer of protection so it wasn’t so vulnerable (even though I knew it did nothing).  

Undressing myself is always an ordeal in itself. The shirts weren’t a problem, it was always the bottom. Trying to figure out how to balance on the affected leg, bend over the sink and hold myself up, while I kick off my bottoms. The slightest tug on my surgical knee would cause it to buckle. My husband would help me into the shower and I used the ledge to pull myself in. 

Showering has never felt so refreshing and blissful in my life.  

 I was able to stand on my own so he just sat outside the shower until I finished. He basically dried me off and carried me out of the shower since I couldn’t seem to lift my leg 1 inch to step out. I learned that if I placed my crutches around the bathroom, I could use the walls, counters, and crutches to essentially move around like I’m in a round-about cubicle.  Also, the single leg RDLs really paid off to pick up things from the floor.  

After my shower, I took my bandages off and cleaned around the wound. There was a lot of gunky skin glue around my incisions. Some were dry and intact, some were kind of wet so I let my knee sit out for a bit before I covered them with new steri-strips.  

This quick video below shows how I did that:  

Some reminders when changing bandages: 

1. Don’t rip the steri-strips off your skin and waking your wound bleed. This is not ripping off a bandaid literally. You can even tack the skin down with your other hand and slowly peal the strips off so it doesn’t peel off the scab as well.  
2. Change your bandages right after you shower because you don’t want to have a soggy wet pad of bacteria sitting on your wound for long. It is also softer and the bandage isn’t so stick so you don’t have to tug at it. If the bandage has fused with your blood, then just cut off as much as you can but I don’t suggest ripping it off if it is hurting.  
3. Do NOT soak your wound in water because that will cause infection. NO BATHS should be taken because the bacteria in your armpits and your butt will cause SEVERE infections in your wound. 
4. Do not cover your wound too tightly because you want it to breath to form a scab. If you seal it too tight, there will be more likelihood of bacteria incubation.  
5. When water runs over your wound, it may sting a bit, but it’s ok, you’re tough! 

10/1/22 – First Car Ride

I got to get out of the house today! Quick trip to Target to get butt wipes and pick up pizza for lunch. I was so excited to go outside into the world for a little bit. I fitted my brace because my leg size had changed with removing all the bandages. Below is a video of how to customize your brace to fit your leg better. 

Brace Fitting Video: 

We decided that getting into the SUV was easier than my sedan since it was higher off the ground. I turned around and sat down first, then swung my leg in. Problem was it was locked in extension so it did not clear the door even though it was opened fully. My husband had to lift my leg up and over like folding me into a V in order to get into the car. Since my knee did not bend in the brace, it did not touch the floor unless I slouched and slid down the seat. Things will be much more comfortable when I can bend my knee and unlock the brace.  

I tried to do some shopping in Target but after trekking the parking lot, I only made it like 20 feet and I was exhausted. Ended up browsing pajamas because it was the closest thing to the exit. Pizza, however, was a pleasant treat after eating soup for the past few days. 

BTW, ask the doctor for a temporary handicap sign. It is a game changer, trust me, when you walk super slow and you’re swollen, the last thing you want to do is hobble around. 10 feet will feel like 100. You can get the necessary forms from your doctor and take it to you local DMV or AAA office to get a temporary handicap placard made.  

LA handicap parking rules dictate that disabled permit holders are entitled to park: 

• In designated disabled parking spaces 
• Next to a blue curb (indicating parking spaces that are reserved for disabled permit holders) 
• Next to a green curb for unlimited time 
• In metered, on-street spaces for free 

Disabled parking permit holders are not entitled to park: 

• In spaces marked with a crosshatched pattern next to a disabled space 
• Next to a red curb, yellow curb, or white curb 

The post 7 – My ACL Journey – Sleeping, Showering, and Riding in a Car After Surgery appeared first on MOTI Physiotherapy.

Today is the day… and I am nervous AF. Had to wake up early, shower, wipe myself down with this antiseptic thing. Which, btw, takes about 10 minutes to air dry while you’re naked or it’s super sticky on your skin. No food after 10 pm last night and no water after 7am this morning. I decided to wear a dress so I can easily change before and after my surgery.  

We get to the hospital and I get admitted into the pre-op area. My nurse was so sweet and she made sure I was comfortable in my bed while they do all the paperwork, give me medicine, and call the docs over a last minute meet n’ greet. 

I met the anesthesiologist first, who informed me I would be getting a adductor nerve block PRIOR to going under general anesthesia. This sensory only nerve block will help block the pain in my knee and lower leg. However, I was freaking out because this lady was going to stick a large needle into my thigh and I’ll still be awake.  

As I’m lying there anticipating the needle situation, my surgeon comes by, Dr. Nima Mehran, and marks my left knee with his signature and a giant fish. He goes “You’ll do GREAT” and steps aside as the anesthesiologist comes back with her ultrasound machine. She asks me to take this pill to ease the nerves and I remember saying something cheeky back to her as the drugs took effect, “So I don’t shit myself when you stick a giant needle in my leg?” Her reaction….yes.  

So without me really even noticing, she was able to do a ultrasound guided nerve block to my adductor nerve at my lower inner thigh. It was painless and I was definitely high on something. Seeing how sensitive I was to drugs, she gave me some antinausea medicine into my IV for prior and after surgery.  

What seems like 5 seconds later, I get wheeled into the OR room and I try to make small talk with everyone around me. They had me transfer from my bed onto the OR bed and as they strap me down, the nurse anesthesiologist was already knocking me out. She put a mask on my face and told me to breath deep. I was drunkingly fighting back saying, “the mask is in my eye” and next you know I’m out.  

When I came to, I felt my thigh was wrapped up really tight, and I knew my quad was harvested. My doting husband was already there next to me and the nurse asked me if I was in any pain. Honestly, I wasn’t sure BUT I was afraid I would be… so I said yes so she pushed some heavy pain meds into my IV. My doc came around and told me that the surgery went well, he tried to repair my ACL but when he bent my knee in the OR to test it, the sutures went right through my ACL and the whole thing tore. He quickly transitioned to harvesting my quad and reconstructed my ACL with it. I pretty much had BOGO surgeries.  

At this point, the nurse asked me if I wanted to go home and I jumped at the word home. I was ready to get out of here. The moment I saw up, I got so high and drowsy, I could not remember the details of getting home. There were flashes of me getting into a wheel chair, standing up and scooting back into the backseat of the car, gagging in the car, trying to walk from the car to my front door and almost falling backwards three times, and going to the bathroom to pee.  

I slept the day away and by the time I woke up it was around 7-8pm. My husband brought me some soup and I could only stomach a small bowl without feeling nauseous. Everyone told me to get ahead of the pain and take the pain meds before I start to feel too much pain. If you were to wait until it hurt so much, the pain meds will not feel like they are working at all. I also had patients tell me to save the pain meds for Day 2-3, when all of the anesthesia has worn off and it hurts the most. 

I ended up taking 650mg Tylenol and 2, 5 mg oxy (4 hours apart) and I was lights out again. 

9/28/22

When I woke up today, I was not in a lot of pain but I kept having this fear that it’ll come soon. My husband gave me another Tylenol and I decided hold on the oxy until I really needed it.  

I spent most of that first day icing, elevating, ankle pumps, and reading. TV and the phone still made me a nauseous.  

This ice machine was a life saver because I could just add frozen water bottles to it and it would stay cold for hours. I just had to make sure that my knee was wrapped up well so I didn’t get burned by the ice.  

The most important thing for the first few days is getting my knee extension back. I made sure I propped my heel up as much as possible and avoided any cushion under my knee that would put it into flexion. It was very uncomfortable with pain in the back of my knee but I knew I had to suck it up or lose the extension. I used my triangle wedge a lot and continuously iced, elevated, and moved my ankle around so I would avoid swelling and stiffness.

The post 6 – My ACL Journey – Hello new ACL appeared first on MOTI Physiotherapy.

Dear ACL,  

I can’t believe the thing I love to rehab the most is now going to be the thing I will have to rehab myself with. The ACL is one of the most unique structures in our body, with the ability to resist sagittal, frontal, and traverse plane forces in our knee. I have been fortunate enough to work in the sports field my entire career and have become an expert at ACL injuries and rehab post-op reconstruction. With my experience and passion for ACLs, I feel like I am one of the best sports physical therapists in the LA region to rehab ACLs. 

I decided to take Lee Taft’s Speeds course to increase my bag of knowledge on return to sports and how I can further enhance my ACL athlete’s rehab as they return to their respective sports. This course is learned by doing and on the second day, I felt confident in my movements. We were working on some agility, fake cutting and pushing off in order to change direction quickly. My friend and colleague Kirk, told me to square up, fake right, cut left. I faked right but my foot was not completely planted, while still on my forefoot, I felt my left knee cave in and a giant POP. Kirk told me he thought I dropped my cell phone on the ground, but it was actually you, my ACL. 

Fast forward to that night, my knee was mildly swollen but I still had most of the range. Hyperextension and weighted end range flexion hurt the most. I could walk on it, but it felt very unstable, like a baby giraffe. Lachman was mildly positive and Pivot shift was not tested because I guarded too much. Negative McMurry and Thessaly test.  

[A little history on my left knee.]  

10 years ago, I was training for a mud run and I strained the back of my knee running on the beach on the sand. There was pain in the posterior knee with end range extension for a few days and it felt like my upper gastroc was strained. Two weeks later my knee felt great, and I did the mud run…and strained the same spot again. Symptoms were the same and lasted a couple days. A few years later, I got my USA Weightlifting Coach Certification, and I was practicing my clean and jerks. I hyperextended my L knee on accident during a lift and flared up my knee in the same way. This year, I stood up and pivoted from my coach and re-aggravated the knee, and then re-aggravated it again walking 35 miles on the cobble stones of Rome. Throughout the 10 years since that first mud run injury, I would consistently work on my hip mobility, my hip stability and strength, and maintained a healthy lifting regimen. However, the L quad was always 1 cm smaller than the right and my L glute was weaker than my R.  

I believe I had sprained or partially tore my L ACL this entire time and this time, it broke up with me completely. 

The post 1 – My ACL Journey – When you broke up with me… appeared first on MOTI Physiotherapy.